Hong Jung Yong, Ko Young Hyeh, Kim Seok Jin, Kim Won Seog
aDepartment of Internal Medicine, Chung-Ang University College of Medicine bDepartment of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine cDivision of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Curr Opin Oncol. 2015 Sep;27(5):392-8. doi: 10.1097/CCO.0000000000000210.
Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is an EBV-positive monoclonal large B-cell proliferative disease that arises in elderly patients older than 50 years. Updated knowledge on geographical/ethnical variations in the prevalence and prognostic impact of EBV positivity, the genetic mechanisms of lymphomagenesis, and the validity of the disease is available.
The poor prognostic impact of EBV positivity is consistent among Asian populations, but not in Western populations. CD30 may be associated with this geographical/ethnical variation. Gene expression analyses have confirmed the enhanced activity of the NF-κB and JAK/STAT pathways and more frequent expression of CD30 in EBV-positive DLBCL of the elderly. A substantial proportion of cases of EBV-positive DLBCL of the elderly occur in young immunocompetent adults; moreover, EBV-positive DLBCL in young adults has a distinct clinical course compared with EBV-positive DLBCL of the elderly.
Further research is anticipated, as follows: first, identifying geographical/ethnical differences in gene expression profiles and CD30 coexpression in EBV-positive DLBCL of the elderly; second, feasibility of the revision of the current disease entity confined to elderly patients; and third, novel therapeutic approaches targeting CD30 and the NF-κB and JAK/STAT pathways in EBV-positive DLBCL of the elderly.
老年EB病毒（EBV）阳性弥漫性大B细胞淋巴瘤（DLBCL）是一种发生于50岁以上老年患者的EBV阳性单克隆大B细胞增殖性疾病。目前已有关于EBV阳性在患病率和预后影响方面的地理/种族差异、淋巴瘤发生的遗传机制以及该疾病有效性的最新知识。
EBV阳性对预后的不良影响在亚洲人群中是一致的，但在西方人群中并非如此。CD30可能与这种地理/种族差异有关。基因表达分析证实，老年EBV阳性DLBCL中NF-κB和JAK/STAT信号通路的活性增强，且CD30表达更为频繁。相当一部分老年EBV阳性DLBCL病例发生在年轻的免疫功能正常成年人中；此外，年轻成年人中的EBV阳性DLBCL与老年EBV阳性DLBCL具有不同的临床病程。
预计将开展进一步研究，如下：第一，确定老年EBV阳性DLBCL基因表达谱和CD30共表达的地理/种族差异；第二，修订目前仅限于老年患者的疾病实体的可行性；第三，针对老年EBV阳性DLBCL中CD30以及NF-κB和JAK/STAT信号通路的新型治疗方法。
